Graduate Medical Education Reform

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Abstract
Objective. —To analyze the potential strategies and costs of house staff substitution under a reformed system of graduate medical education. Design. —An economic model using two scenarios for substitution of house staff (residents and fellows): (1) a lower-cost model under which nonphysician providers assume many house staff responsibilities, but additional aspects of their workload are taken over by staff physicians, nurses, and ancillary personnel; and (2) a higher-cost traditional model that relies more heavily on staff physicians to replace house officers. Setting. —US teaching hospitals. Main Outcome Measures. —Projected net substitution costs of house staff on a per full-time equivalent basis and aggregate national cost estimates of substitution. Results. —Net annual house staff substitution costs were estimated to be $58000 and $77000 per replaced full-time equivalent house officer, respectively, under the two scenarios. Assuming elimination of approximately 23200 house staff under a reformed system, total (net) substitution costs to teaching hospitals were estimated at approximately $1.4 billion to $1.8 billion nationally on an annual basis. Conclusions. —Graduate medical education reform, while likely to result in substantial long-term cost savings, will necessitate transitions in service provision that are likely to generate some new costs in the short term. (JAMA. 1994;272:53-58)

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